Inoue Hayato, Oyama Ryunosuke, Nakamura Kimitaka, Inokuchi Akihiko, Hamada Takahiro, Izumi Teiyu, Imamura Ryuta, Ebihara Toshihiro, Inoue Takahiro, Arizono Takeshi
Department of Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN.
Cureus. 2023 Feb 24;15(2):e35407. doi: 10.7759/cureus.35407. eCollection 2023 Feb.
Background The purpose of this study is to clarify the current status of the prescription of postoperative bisphosphonates for patients with hip fractures and to explore the factors that prevent the postoperative prescription of bisphosphonates. Methods Of 180 patients with hip fractures treated surgically at our hospital between August 2019 and April 2020, 149 patients (46 men and 103 women; mean age: 83.9 ± 9.0 years), excluding 31 patients already prescribed bisphosphonates or denosumab, were included in the study. All patients were treated based on our clinical pathway, and their risk of jaw osteonecrosis was evaluated prior to the initiation of bisphosphonates by a dentist in our hospital. We collected data from the medical records on osteoporosis treatment interventions at admission and discharge, the reasons why postoperative bisphosphonates could not be prescribed at discharge, the proportion of patients who had follow-ups at our hospital, and patients' osteoporosis treatment status. Results Eighteen (12.8%) and 95 (63.8%) patients were prescribed anti-osteoporosis drugs at admission and discharge, respectively. One hundred and twenty-one patients (86.8%) could not be prescribed postoperative bisphosphonates at discharge - 71 (58.7%) because of oral hygiene problems, 34 (28.1%) because they did not have regular dental consultations, seven (5.8%) because of renal dysfunction, eight (6.6%) because of poor cognitive and swallowing function, and one (0.8%) because of medication side effects. Forty-nine patients (32.9%) went to our hospital for follow-up and 11 were introduced to bisphosphonates or denosumab at follow-up. Conclusions The number of patients with hip fractures who were prescribed postoperative bisphosphonates was low in our study. The oral hygiene problems identified by dentists accounted for responsible for the low prescription rate of postoperative bisphosphonates. Therefore, coordination with dentists may be important to increase the postoperative bisphosphonate prescription.
背景 本研究的目的是阐明髋部骨折患者术后双膦酸盐类药物的处方现状，并探讨阻碍术后使用双膦酸盐类药物处方的因素。方法 在2019年8月至2020年4月期间于我院接受手术治疗的180例髋部骨折患者中，排除31例已开具双膦酸盐类药物或地诺单抗的患者，149例患者（46例男性和103例女性；平均年龄：83.9±9.0岁）纳入研究。所有患者均按照我们的临床路径进行治疗，在开始使用双膦酸盐类药物之前，由我院的一名牙医评估其颌骨坏死风险。我们从病历中收集了入院和出院时骨质疏松治疗干预措施的数据、出院时无法开具术后双膦酸盐类药物的原因、在我院进行随访的患者比例以及患者的骨质疏松治疗状况。结果 分别有18例（12.8%）和95例（63.8%）患者在入院和出院时开具了抗骨质疏松药物。121例患者（86.8%）出院时无法开具术后双膦酸盐类药物——71例（58.7%）是因为口腔卫生问题，34例（28.1%）是因为未定期进行牙科会诊，7例（5.8%）是因为肾功能不全，8例（6.6%）是因为认知和吞咽功能差，1例（0.8%）是因为药物副作用。49例患者（32.9%）到我院进行了随访，其中11例在随访时被推荐使用双膦酸盐类药物或地诺单抗。结论 在我们的研究中，髋部骨折患者术后开具双膦酸盐类药物的人数较少。牙医发现的口腔卫生问题是术后双膦酸盐类药物处方率低的原因。因此，与牙医协调对于提高术后双膦酸盐类药物的处方率可能很重要。
